My 10 year old daughter was diagnosed with type 1 diabetes about seven weeks ago. At her one month follow up visit, the doctor suggested testing her for lupus and also indicated that the diabetes did not come from my father’s side of the family (his mom and brother both had type 2), but from my mom who has hyperthyroid disease. She was diagnosed about three years ago. How is this possible? Would it also be possible for her to have lupus? What about ITP [ideopathic thrombocytopenic purpura, another disorder that may be autoimmune in nature]? My daughter was tested for it about six months ago when she developed tiny red spots on her hands. The results were negative. Should she be re-tested for ITP? I have not seen the spots again.

For some time it has been recognised that autoimmune or Type 1A diabetes may occur in association with other autoimmune disorders. The syndrome is known as Autoimmune Polyglandular Syndrome type 2. Diabetes is not always present, but, when it is, the most commonly associated problems are hypothyroidism [underactive thyroid gland], and sometimes hyperthyroidism [overactive thyroid gland], the celiac syndrome in around 10% as shown by a positive anti-transglutaminase antibody test and in around 1% a positive anti-21hydroxylase antibody test indicating the possibility of problems with the adrenal glands. So, it is possible that some part of your daughter’s genetic predisposition to diabetes came through your mother. Some recent studies in Sweden, however, have shown that in a sample of supposedly type 2 diabetics, as many as a quarter could be what is called LADA (Late Autoimmune Diabetes in Adults). So it could be that the type 1A diabetes came from both sides of your family.

Lupus is recognised as an autoimmune disorder, but not one that is associated with diabetes or usually tested for in these circumstances. Likewise, I see no reason to retest for ITP.

DOB